共病指数与急性冠状动脉综合征患者冠状动脉病变程度及早期预后的相关性^*

Correlation study between comorbidity index and the degree of coronary artery lesions and early prognosis in patients with acute coronary syndrome

摘要

目的 探究共病指数与急性冠状动脉综合征(ACS)患者冠状动脉病变程度以及早期预后的关系。方法 选择2023年10月—2024年11月南京大学医学院附属金陵医院收治行经皮冠状动脉介入(PCI)治疗的169例ACS患者进行回顾性分析。收集患者临床相关资料,计算查尔斯共病指数(CCI),并采用Gensini评分对冠状动脉病变的严重程度进行量化评估,统计患者住院期间主要不良心血管事件(MACEs)的发生情况。采用Spearman相关性检验评估CCI评分与冠状动脉病变程度及MACEs发生的相关性,采用多因素logistic回归分析在院期间发生MACEs的风险因素,采用ROC曲线评估CCI评分对MACEs发生的预测能力。结果 住院期间发生MACEs者40例,未发生者129例。住院期间MACEs组的年龄、糖尿病患病率、白细胞计数、尿素氮、CCI评分、Gensini评分、冠状动脉病变分支数、植入支架个数均高于非MACEs组(P<0.05)。Spearman相关性检验结果显示,CCI评分与ACS患者Gensini评分、冠状动脉病变分支数、植入支架个数及住院期间MACEs的发生呈正相关(P＜0.05)。logistic回归分析表明,CCI评分是ACS患者住院期间发生MACEs的独立危险因素(OR=5.364,95%CI:2.625~10.962,P＜0.001)。ROC曲线表明CCI评分预测MACEs的曲线下面积为0.878(95%CI:0.820～0.937,P＜0.001),最大约登指数为0.608,灵敏度为82.5%,特异度为78.3%,最佳截断值为2.5分。结论 ACS患者CCI与冠状动脉病变程度及MACEs的发生相关,针对不同CCI分层的患者应采取不同的预防措施。

Abstract

Objective To investigate the relationship between the comorbidity index and the degree of coronary artery lesions as well as early prognosis in patients with acute coronary syndrome(ACS). Methods A retrospective analysis was conducted on 169 ACS patients who underwent percutaneous coronary intervention(PCI) at Jinling Hospital between October 2023 and November 2024. Clinically relevant data was collected, and the Charlson comorbidity index(CCI) was calculated. The Gensini score was used to evaluate the degree of coronary artery lesions in patients. To statistically analyze the occurrence of major adverse cardiovascular events(MACEs) during the hospitalization of patients. The spearman correlation test was used to evaluate the correlation between the CCI score and the degree of coronary artery lesions as well as the occurrence of MACEs. Multivariate logistic regression model was used to analyze the risk factors of MACEs during hospitalization, and the ROC curve was used to evaluate the predictive ability of CCI score for the occurrence of MACEs. Results 40 cases of MACEs occurred during hospitalization,while 129 cases did not.The MACEs group showed significantly higher values than the non-MACEs group in terms of age, prevalence of diabetes, white blood cell count, blood urea nitrogen, CCI score, Gensini score, number of diseased coronary branches, and number of implanted coronary stents (P<0.05). Spearman correlation analysis revealed that the CCI score was positively correlated with the Gensini score, number of diseased coronary branches, number of implanted stents, and the occurrence of MACEs in ACS patients (P<0.05). Logistic regression analysis indicated that the CCI score is an independent risk factor for MACEs in ACS patients (OR=5.364, 95%CI:2.625-10.962,P<0.001). ROC curve analysis demonstrated that the area under the curve (AUC) for predicting MACEs using the CCI score was 0.878 (95% CI: 0.820-0.937, P<0.001), with a maximum Youden index of 0.608, sensitivity of 82.5%, specificity of 78.3%, and an optimal cutoff value of 2.5 scores. Conclusion The CCI is associated with the degree of coronary artery lesions and the occurrence of MACEs in ACS patients. Different preventive measures should be implemented based on patients' CCI stratification.

关键词

急性冠状动脉综合征 / 查尔斯共病指数 / 冠状动脉病变程度 / 主要不良心血管事件

Key words

Acute coronary syndrome / Charlson comorbidity index / Degree of coronary artery lesions / Major adverse cardiovascular events